In the seven months that the novel coronavirus has stalked the world, we’ve learned a lot of science about how the virus spreads, how it kills and how we develop immunity (or not).
That knowledge has forced us to change our beliefs and approaches.
Masks went from irrelevancy to the forefront of public-health measures. We went from obsessing about surface contamination to fretting about ventilation. We shifted from fearing those who cough, to wondering who was asymptomatic and spreading disease silently.
One of the important lessons to draw from this is that we need to follow the evidence. Public-health officials changing their guidance is not flip-flopping – it’s adapting.
The other key takeaway is to beware of false dichotomies. The coronavirus is not spread only by droplets or aerosols, but likely by both. Similarly, we should be equally wary of symptomatic and asymptomatic spread, but also realize the coronavirus does not spread that easily.
The distance and the duration of exposure matters, as does the environment. We’re way safer outdoors than indoors, and when not speaking at all instead of speaking/singing/yelling moistly. We can now direct our wrath at overeager karaoke aficionados instead of runners.
Most important of all, we have to dispense with the fiction that recovery efforts will be either about the economy or about health. The surest way to get the economy back on track is to limit – or ideally, eliminate – the spread of COVID-19.
Canada is not the U.S. – where many states have embraced a destructive “reopen and illness be damned” attitude – but many provinces have loosened restrictions hastily. We didn’t need to open bars when we did; there is no logic to allowing gatherings of 250 people, and as important as it is to get kids back to school, class sizes of 30 students should have been a non-starter.
We’re seeing the consequences of that short-sighted impatience as cases creep up again. We are nervous about what will happen after Labour Day, with a lot of kids returning to school, many workers going back to offices and the cooling weather chasing us indoors.
The trepidation is justified, and we have to prepare ourselves psychologically for the possibility of more lockdowns.
What is not certain, though, is an inevitable second wave. Increasingly, it appears that the coronavirus pandemic will play out as one long wave, with the occasional ripple when we become complacent.
We should not assume there will be huge spikes in deaths in the fall. Nor should we see low mortality as the sole measure of success. One of the most unpleasant surprises that COVID-19 has delivered is that it appears to cause long-term damage, especially to the heart. We are seeing a small but significant number of those who get infected developing chronic illness. We call them “long-haulers.”
The most intriguing development to come, however, will be in our approach to testing.
Since the outset of the pandemic, the mot d’ordre has been to test, test and test some more. Canada has done more than six million tests. But the PCR test – the current standard, a molecular tool that tells us if someone has been infected – is slow, costly and has limitations.
As we learn to live with the coronavirus and as social interactions escalate, what we need to know is not so much who has been infected, but who is still infectious. For that, we need a rapid diagnostic test, one in which you swab your nose or spit in a tube and get results within minutes. If you’re negative, you can head off to work or school in confidence.
The knock against diagnostic tests is that they are not accurate, but that’s not a deal-breaker. If you’re positive, you stay home, and then get a follow-up test. But a lot of unnecessary tests and quarantines can be avoided.
Finally, we are learning a lot about immunity.
Not that long ago, we were certain that people who were infected with coronavirus would develop immunity. There was serious discussion about “immunity passports” so the recovered could return to work.
Now, it appears immunity may be fleeting, and re-infection possible. But again, these are not black-or-white issues.
Most people who get infected have at least some immunity, and it seems to last for some time, if not forever. That bodes well for vaccine development.
As vaccines are tested in controlled conditions and in the real world, you can bet our views on immunity will change again. And that’s okay. As the pandemic evolves, so too must our responses.
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André Picard